By Amy Worden, Inquirer Harrisburg Bureau

Posted: July 03, 2013

HARRISBURG - As the health-care industry and advocates for the poor anxiously watched and waited, a soft-spoken Bucks County Republican took the state House floor Monday night to break with his caucus and call for expansion of health insurance for hundreds of thousands of lower-income Pennsylvanians.

"I believe in bottom of my heart that this is the right thing to do," said Rep. Gene DiGirolamo, who is chairman of the House Health and Welfare Committee, to applause from Democrats.

But Republican leaders had already stripped Medicaid expansion from the bill at hand, and notwithstanding DiGirolamo's plea, the GOP-controlled chamber voted Monday night to send the bill back to the Senate.

Its fate there is uncertain. The Senate GOP majority hasn't said whether it will try to restore Medicaid expansion later this week.

But after a weekend of legislative drama beset with partisan and intraparty fights, a moment of bipartisanship on Medicaid may have just evaporated in the Capitol.

Earlier, senators from both parties had fa shioned a rough accord on expanding Medicaid, with conditions and caveats written into the law. Even Gov. Corbett, who initially opposed expansion, signaled he might support the move.

But 33 Republicans in the other, more conservative chamber had mutinied Friday, warning that they would vote against the entire $28.4 annual billion budget if any related bills included language to expand Medicaid.

When House Majority Leader Mike Turzai convened a key committee of leaders Monday morning, they stripped the expansion language out of the welfare code - a necessary and usually uncontroversial piece of the state budget package.

On the floor Monday, Turzai (R., Allegheny) explained that he believed any such expansion should be worked out between the governor and federal officials, not the legislature.

The expansion is an option available to states, with the federal government picking up most of the tab, under the health law known as Obamacare. Corbett initially opposed it, warning of future costs for the state. But he let it be known over the weekend that he might be able to live with the Senate's language.

With all 92 House Democrats favoring Medicaid expansion, DiGirolamo needed only to convince 10 fellow Republicans.

"This is going to insure our working poor in every one of our districts who have no health insurance," said the lawmaker, whose lower Bucks district is home to plenty of working poor. "It's heavily tilted toward women who work in day care, beauty salons and veterans."

But in the end, only one other Republican, Rep. John Taylor of Philadelphia, joined him, and the effort failed, 108 to 94.

The Medicaid showdown came as House cleaned up the remaining budget-related bills - such as the tax code, where language critical to the rescue plan for Philadelphia schools resides. That bill passed Monday night.

As the Republican-controlled Senate's next move on Medicaid expansion?

"We will review our options and make a determination on how to best proceed," said an unusually reserved Erik Arneson, spokesman for the chamber's Republicans.

Arneson said the Senate was likely to take up the bill Wednesday.

The House also removed from the welfare code a proposed section renaming the Department of Public Welfare as the Department of Human Services - a change that had also enjoyed bipartisan support before it reached the House. But that proposal was later restored in a stand-alone bill.

States that opt to expand Medicaid coverage under the Affordable Care Act can look forward to the federal government paying 100 percent of the costs for the first three years, beginning in 2014. After that, states pick up 10 percent of the costs.

Independent studies have estimated that Medicaid expansion in Pennsylvania would provide insurance for as many as 600,000 adults who are mostly uninsured now, would create up to 40,000 jobs, and would ease the burden on hospitals across the state, which now pay more than $1 billion year for uncompensated care. Hospitals lobbied fiercely for the expansion.

Another champion of the move was State Sen. Vincent Hughes (D., Phila.). He had worked with his Republican counterparts to craft a bill that included some of the provisions sought by Corbett, including a requirement that recipients contribute small co-pays.

Hughes noted after Monday night's House vote that legislators have health-care coverage.

"We all have health insurance," he said. "That increases the level of hypocrisy in this."

Andre Butler, 47, of Philadelphia, who works as a temporary catering server and cannot afford private insurance, spent three days in the Capitol last week hoping to see the expansion enacted. Butler said he suffers from chronic back pain and needs costly MRIs.

"I was certainly disappointed," he said after the vote. "But it's not over. We know Medicaid expansion is still important, we're going to make sure it gets done."